Purpose: To assess the impact of requiring reintubation in infants < 1000g on NICU course and outcomes.
Methods: Retrospective analysis of all surviving infants <1000 grams from a large neonatal database from 6/2006-9/2011. Infants included were all those initially ventilated and then either extubated successfully and never reintubated, extubated and reintubated within 14 days and those reintubated later. Outcomes measured were chronic lung disease (CLD), necrotizing enterocolitis (NEC), severe intraventricular hemorrhage (IVH), severe retinopathy of prematurity (ROP), later sepsis, need for high frequency ventilation(HFV), and length of stay (LOS). Multivariate regression analysis controlled for gestational age (GA), birth weight (BW), and gender.
Results: 3027 infants were born during the study period and 1155 met inclusion criteria. After controlling for GA, BW and gender reintubated infants were significantly more likely to develop CLD(OR-5.11), IVH(OR-2.9), ROP(OR-4.3), sepsis(OR-2.9) and NEC(OR-3.1), receive systemic steroids(OR-6.8) and have a significantly longer LOS.
Comparing only those reintubated, infants intubated after day 14 required more HFV days and were ventilated more days initially.
Conclusion: Initial need for intubation and MV did not portend a negative outcome; however, the need for reintubation and MV a 2nd time significantly altered the clinical course for infants < 1000g. This clinical event redefines illness severity after the 1st week of life. Early identification of infants likely to experience negative short and long-term outcomes is crucial in developing future therapies for this at risk population.